Doctors' hopeful outlook can be a potent tonic for patients

Even in difficult situations, taking the time to pay attention to a patient's emotional and spiritual as well as medical needs can work wonders.

In the Lodz ghetto in Poland, home to as many as 204,000 Jews during World War II, there were 170 doctors, as well as a few nurses and midwives, according to diaries and memoirs. Like all the others, they lived with the daily terror of being shipped off to a death camp.

There was almost no food, no medication and certainly no X-ray machines, laboratories or any of the other accouterments that we think of as essential to medicine today. And yet, when there was nothing to give the sick, the Lodz doctors did find something.

"These doctors gave people hope," said Dr. Harold Bursztajn, a Beth Israel Deaconess Medical Center psychiatrist whose parents lived in the ghetto and who spoke about the Lodz experience at a recent meeting for colleagues.

The lesson for today's doctors, who are often demoralized and squeezed ever more tightly by time and budget constraints, is that even "under the most extreme circumstances, in the face of isolation, helplessness and hopelessness, all could make meaningful choices," Bursztajn said. "This provides an ongoing lesson on what is possible.

"Even when there are no medicines, you can use yourself," he said. "The doctor becomes the medicine."

Ghetto doctors armed with little more than kindness and hope twice saved the life of Bursztajn's father, Abraham. The first time, Bursztajn said, was when his father fainted after being tortured. A ghetto doctor revived him.

"I will die here," his despairing father said to the doctor, an older man. "One of us will, but it will be me," the physician answered. "I do not have any way to treat you, but you are young. If you don't give up hope, you will survive."

Thanks to that doctor, his father did maintain hope, Bursztajn said, and that hope fueled his courage to resist. One night, Abraham sneaked out of the ghetto to steal cement with which to build bunkers for hiding. The plan was to put the bunkers under the ghetto's stinking septic system to throw off the bloodhounds the Germans used to hunt Jews. While sneaking back carrying a 100-pound bag of cement, he was shot in the leg by a German patrol. Leaving a bloody trail, he somehow got back. But his father knew the Nazis would see the blood and look for him if he failed to show up at the next morning's roll call.

A ghetto doctor came to him. He had no instruments, but sterilized a coat hanger as best he could and dug out the bullet from Abraham's leg. With his leg bandaged tightly to stop the bleeding, Abraham made it to roll call and helped build the bunker, which eventually hid -- and saved -- 15 Jews.

"Acts of heroism like this were repeated over and over in the Lodz ghetto," said Geoffrey Brahmer, a Holocaust educator who spoke about the Lodz ghetto at the meeting. "Some people were so courageous in the most horrible conditions and yet they still kept their humanity. By golly, if they can do it, we can do it in the midst of our little stressful lives."

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Lessons from Lodz

Dr. Salomea Kape, a retired anesthesiologist now living in Larchmont, N.Y., was a teenager in the Lodz ghetto. She remembers how her mother, Rachel Herschenberg, a midwife, also saved lives with little but her hands, her knowledge and her presence.

One night, recalled Kape, who attended the meeting, a desperate young man left his bunker and made his way to where Herschenberg lived, saying his wife was bleeding to death after childbirth. He had already asked a doctor to help, but the doctor refused, saying it was too dangerous to go out with Nazi guards all around.

"I begged her not to go," Kape said. But Rachel Herschenberg went. The baby had just been born. With no way to clean her hands, she simply reached inside the dying woman and removed the placenta, stopping the bleeding. She even went back the next night to check on her patient, who survived.

"This dimension of medicine, which is to give to people from your heart and from your soul is, to my mind, what makes medicine a noble profession," said Dr. Jerome Groopman, author of "The Anatomy of Hope," and chief of experimental medicine at Beth Israel Deaconess.

"A patient taught me something in an analogous situation," Groopman continued. "It was a woman with very advanced breast cancer who was dying. I had given her all the therapy I knew, including experimental drugs. I said to her that I had nothing left to give her.

"She said, 'No, you are wrong. You have a medicine -- our friendship.' That meant that, when everything is stripped away, being present and caring has an enormous meaning for people."

Dr. Abraham Morgentaler, a Beth Israel Deaconess urologist whose parents, childhood sweethearts, survived the Lodz ghetto together, agreed. "Even under the most difficult circumstances, individuals made heroic, noble decisions to 'do the right thing.' The lesson for young doctors is that we have a choice about how we walk through this world."